Over 200 “mystery” calls made to four state agencies, with common consumer questions; California agencies largely met key standards,But with crush of calls expected, need more consistent, coordinated, prioritized effort.

Groups argue consumer assistance needs to be a priority as millions of Californians get new options, new benefits and new consumer protections under health reform;The report shows the right ingredients are there—but they need to be put together.

Budget (including May Revise) debate will include consumer assistance capacity;Exchange to discuss consumer assistance and service center issues at June meeting.

California consumers can and do get answers from key state agencies to their questions and concerns about health care—and mostly timely, accurately, and with good service. However, the results were sometimes uneven, and the state is going to need to augment, improve, and better coordinate its consumer assistance capacity as it approaches the opportunity and challenge of health reform. That’s the finding of a new study by Health Access, California’s statewide health care consumer advocacy coalition, which conducted a survey of over 200 “mystery shopping” calls to four California health agencies.

Over a dozen callers posed questions to four state health agencies on enrollment in state coverage programs, or concerns about their coverage with private insurers. The callers rated their experience—both in quantitative measure like the time it took to pick up the phone and reach a customer service representative, and qualitative measures, such as the person’s knowledge and professionalism.

With health reform being implemented over the next few years, California needs to augment and improve its consumer assistance capacity, so that millions of Californians are best able to take advantage of their new options, new benefits, and new consumer protections. The report concludes that all the ingredients are there—different state departments have shown different strengths, and a better coordinated, better resourced focus can provide world-class customer service–if this goal is made a priority.

Over 200 calls were made, with 50 calls each placed to four agencies: the Department of Insurance; the Department of Managed Health Care; the Department of Health Care Services (which runs Medi-Cal) and the Managed Risk Medical Insurance Board (which runs the Healthy Families program and the Pre-Existing Condition Insurance Program). While there was some variation between departments (who were asked different questions based on their authority), the results were generally consistent with standards for hotlines for Medicare and Social Security.

* State agencies averaged 10 seconds for time to first connection, with the best agency at 7.3 seconds. In most cases, consumers only needed to go through two automated questions response units (ARUs) to reach a live person.

* While over 80% of the calls reached a live person, none of the agencies met the 94% standard that Social Security sets for itself. The average wait time to get a live person was less than 5 minutes, with most agencies averaging at 2:20 minutes.

* Our evaluators gave their average customer service ratings on accuracy, promptness, and knowledge a 3.7, on a scale of 1-5, with the best departments getting a 4.3.

The report serves as a baseline to evaluate California’s current consumer assistance capacity, as key decisions will be made in the next few months. This includes:

in the state budget allocations for each of the four departments (including those supported by federal funds and grants and by fees on insurers)

in Administration’s revamping of the Office of the Patient Advocate as part of its implementation of SB922 (Monning) passed last year, and

at the Exchange, which will begin unveiling its plan for their customer service call center at their June meeting.

Many of the departments did well, showing the positive ingredients that can be assisted. The report offers a “recipe” for providing quality consumer assistance:

1. Access

consumers should be able to reach a customer service representative (CSR) close to 95% of the time (Model Agency: CDI)

agencies should answer calls quickly and ensure short hold times – the wait for a live CSR should be no longer than 4 min (Model Agencies: CDI, MRMIB)

customer service representatives should be knowledgeable – score at least 4 out of 5 by callers rating CSR Knowledge (Model Agencies: MRMIB, DMHC)

agencies should adopt continual training programs to keep staff informed of changes in policy and be able to provide up to date information reflecting any changes within 24 hours (Model Agency: MRMIB)

3. Performance Management

agencies should continually monitor quality of call center operations and service (Model Agency: CDI) – CDI has clear mechanisms in place to evaluate the quality of the customer service their CSRs provide, with regular audits and evaluations

4. World Class Customer Service

agencies should provide consumers with excellent customer service, act as advocates for consumers, and provide warm hand offs when consumers need help from other places (Model Agency: DMHC)

In other news, Assembly and Senate Appropriations Committees have been considering and voting on a range of bills related to implementing health reform, many of which are heading to floor votes before the end of May. Health Access’ Twitter (http://www.twitter.com/healthaccess) and blog (http://blog.health-access.org) feature ongoing updates on the legislative progress of this legislation and budget items, with detailed description of policy hearings here, here, here, here, here, and here.

Also, we will put out timely updates in the next several days on blog, Twitter, Facebook, and E-mail as we learn more about the state budget and the expectation of additional cuts in the May Revise.